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Getting Proactive about Preventionby Rachel Williams News reports of American health habits often paint a bleak picture—not enough exercise, unhealthy eating habits, irregular cancer screening exams, and the list goes on. But a different picture seems to be emerging at The University of Texas M. D. Anderson Cancer Center. Recently, M. D. Anderson relocated and substantially expanded its Cancer Prevention Center. Since opening its doors earlier this year in the new Cancer Prevention Building—and doubling the number of treatment rooms—the Cancer Prevention Center has seen a substantial increase in patients. Some patients want to know if their family’s predisposition to cancer has a genetic component; others want to find out what toll smoking or sun damage may have taken; others may want an annual screening exam or advice on how to prevent cancer. Whatever their reasons, if the brisk pace of business at the Cancer Prevention Center is any indication, people are not just getting the message about cancer prevention, they are also taking action.
“We have already seen almost 15,000 people this year, a 22% increase over last year,” said Therese B. Bevers, M.D., an associate professor in the Department of Clinical Cancer Prevention and the medical director of the Cancer Prevention Center. “The increased space allows us to accommodate more patients and expand our participation in clinical trials, including multinational prevention studies, as well as prevention research at M. D. Anderson.” According to Dr. Bevers, most people who come to the Center are concerned about their risk for cancer. They may have a family history of cancer or a personal medical condition that would put them at higher risk for cancer, be smokers, or have a precancerous condition such as lobular carcinoma in situ of the breast. “These patients are seeking specialty information about cancer risk that pertains specifically to themselves. They are asking for risk-reduction strategies that they can implement and want risk-based cancer screening recommendations,” said Dr. Bevers. Dr. Bevers chose the specialty of cancer prevention because she enjoys educating patients. “I like the process of risk assessment and being able to explain risks and risk reduction,” she said. Dr. Bevers explained that there are three components of cancer prevention: risk assessment, risk reduction, and screening. Cancer risk assessment Risk assessment takes a comprehensive look at risk factors, including an inherited predisposition to cancer. “We don’t do genetic testing on every patient, but we assess them to see who should go through the genetic counseling process. Additionally, we conduct more formal evaluations to determine whether genetic testing is needed,” said Dr. Bevers. Prevention specialists also assess population-specific risk factors that may contribute to a person’s cancer risk. Using that information, they make risk-based recommendations. For example, when they assess a 30-year-old woman whose mother had breast cancer at age 35, they determine whether she needs to be screened earlier or more often than the average woman, and they consider other risk-reduction options available to her on the basis of her level of risk. Someone with an inherited risk might need to think about options, such as prophylactic surgery, that a person without an inherited risk would not consider. Depending on the patient and the situation, there may be a need for extra screening in the future, such as annual breast magnetic resonance imaging and mammography or follow-up exams at the Center every 6 months. A patient without an inherited risk for breast cancer but with, for example, atypical hyperplasia shown on a biopsy might receive information about taking tamoxifen, which has been found to reduce breast cancer incidence in women with an increased risk for the disease. “Our recommendations are very specific and individualized based on a patient’s personal risk factors,” explained Dr. Bevers. Cancer risk reduction
Risk reduction focuses on three areas: (1) tobacco cessation, (2) healthy lifestyle (exercise, nutrition counseling), and (3) chemoprevention. With regard to chemoprevention, M. D. Anderson is one of more than 400 centers participating in the Study of Tamoxifen and Raloxifene (STAR) to determine the role of these drugs in breast cancer prevention. It is also participating in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) for prostate cancer. Results from these studies will help determine what steps people can take to reduce their risk of cancer. Cancer screening The screening tests offered at the Center include mammographies, breast exams, prostate exams and prostate-specific antigen blood tests, and Pap smears. “In addition to offering the full spectrum of cancer screening, we have research going on in areas where there is no recognized screening as of yet,” said Dr. Bevers. For example, researchers at M. D. Anderson are conducting a clinical trial of lung cancer screening, comparing spiral computed tomography with chest x-rays to see if it can detect cancer at an earlier stage, when it is more treatable. Similarly, there are no recognized screening tests available for ovarian cancer, but an ongoing study is evaluating how different blood tests may help identify ovarian cancer at an earlier, more treatable stage. Dr. Bevers believes that it is advantageous that the Cancer Prevention Center provides a full spectrum of prevention services. “A woman may come in for her breast exam, mammogram, and pelvic exam, whereas at another place, she’d have to go to two separate centers to get the tests. Likewise, if we identify a woman who has an inherited predisposition to BRCA1, we’re looking at increased susceptibility to both breast and ovarian cancer. Having combined services at the Prevention Center allows us to focus on the whole risk spectrum, and risk-reduction screening allows us to put together the best overall plan for the individual.” Diagnostic program The Cancer Prevention Center also has some diagnostic programs, including an undiagnosed breast clinic for women who have found a lump or had an abnormal mammogram. Diagnostic services are also offered for abnormal uterine bleeding, abnormal Pap smears, and suspicious skin lesions. If diagnostic tests indicate that the patient does not have cancer, specialists at the Center nevertheless advise him or her on how to reduce the risk of getting it later. Dr. Bevers explained the importance of these diagnostic programs: “We added on the diagnostic piece because it was a natural flow from our screening program.” Multidisciplinary approach The Cancer Prevention Center has a multidisciplinary approach; its staff meets weekly with other specialists at M. D. Anderson to review patients’ findings and histories. For example, if a patient has benign breast lesions, Dr. Bevers and her staff consult with radiologists, pathologists, and clinicians to determine whether the lesions suggest an increased risk of breast cancer or are completely benign. The goal of the Cancer Prevention Center is to provide specialized cancer prevention and, in some cases, cancer diagnosis. Dr. Bevers said, “For the vast majority of patients, screening is done in primary care settings. It is unique to be able to provide an extension of primary care within a cancer hospital. In fact, all of the faculty in general prevention are family physicians who have focused their careers on cancer prevention. They are prevention specialists.”For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789. Other articles in OncoLog, July/August 2005 issue: Home/Current Issue | Previous Issues | Articles by Topic | Patient Education ©2008 The University of Texas M. D. Anderson Cancer Center |
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